International Poster Journal of Dentistry and Oral Medicine, Supplement PDA/2015

Case Description: Male patient, 52 years of age, non-smoker, showed-up in the appointment with complaints of tooth hypersensitivity and concerns about the generalized gingival recessions. After a diagnosis of generalized chronic moderate periodontitis, a cause-related periodontal therapy was performed. Posterior to the re-evaluation, indicating a healthy periodontal condition, patient functional concerns persisted regarding the presence of the multiple gingival recession. After detailed discussion with the patient about the several therapeutic options and their prognosis, multiple root coverage in the 1st quadrant (11, 12, 13 and 14) and in the 2nd quadrant (21, 22, 23 and 24) was decided to do in a first instance, using coronal repositioning flaps and site-specific subepithelial connective tissue grafts (SCTG's). The aim of this clinical case is to describe, step by step, the entire surgical process performed as well as to illustrate the initial 6th month follow-up condition. Discussion: The selection of the surgical technique for the treatment of gingival recessions depends on several factors. Anatomical conditions, long-term stability and patient preferences and expectations should be taken into consideration when elaborating the treatment plan. The use of site-specific SCTG's is related to the long-term stability of root coverage in the areas of higher risk of relapse (patient main concern) and not with aesthetic reasons. Conclusion: Coronal repositioning flaps and site-specific subepithelial connective tissue grafts (SCTG's), can be successfully used in multiple root coverage. Keywords: gingival recessions, periodontal plastic surgery, root coverage, periodontal long-term stability, sub-epithelial connective tissue graft, coronally advanced flap

Male patient, 48 years old, came to dental clinic for a routine visit. After panoramic radiography, it is evident the presence of large dimensions radiolucent image, unilocular and edges defined in the anterior mandibular region. The history revealed the occurrence of trauma to the anterior mandibular region. Enucleation of the lesion and guided bone regeneration with resorbable synthetic bone substitute and membrane was made. Keywords: radicular cyst, trauma

Description of the case: A 81-year-old male patient, without systemic disorders, came to the appointment referring lack of masticatory function. It was planned six implants in upper atrophic maxilla (Implant Direct - Swish Plus), with immediate placing of 2 implants and 2 posterior tilted implants due to the severe pneumatization of maxillary sinus and bone ridge resorption. The prosthetic phase was initiated 4 months after implants surgery. Discussion: The placement of tilted implants with the objective of reduce the necessity of bone grafts and increase bone support has been reported by several authors and allows a viable rehabilitation, minimally invasive and with good acceptance by the patient. The placement of tilted implants is a viable surgical alternative in anatomic regions such as: the anterior or posterior wall of the maxillary sinus, the palatal curvature or the pterygoid process. This treatment option, allied to the use of longer implants, allows an improved primary stability favoring immediate loading. Also, allows the adequate distribution of the implants, resulting in a more uniform distribution of forces and the decrease or elimination of the cantilever. Some authors have been questioning the biomechanical qualities of this surgical option; however there are no statistical differences when compared with implants placed conventionally. Conclusions: Tilted implants allow an implant-supported rehabilitation of atrophic maxilla, decreasing the waiting time, the patient's morbility and the costs of the treatment. Keywords: rehabilitation, atrophic maxillar, tilted implants

Crown dilaceration of permanent teeth occurs due to the non-axial displacement of the already formed hard tissue portion of the developing crown at an angle to their longitudinal axis due to trauma to the primary predecessor. (1,2,3) The prevalence of crown dilaceration constitutes 3% of total injuries in developing teeth and is usually because of intrusion or avulsion of primary predecessors. (1,2) Crown dilacerations with palatal angulation of the crown occur most commonly in maxillary incisors, whereas labial angulation is more common in mandibular incisors .(1,2,3) The final diagnosis is made after a full clinical and radiographic exam and a careful report of medical history by the dentist. (3) Keywords: coronary dilaceration, dental trauma, primary teeth, central lower incisor, morphological disturbances, odontopediatrics

Introduction: Oral health community intervention must be an opportunity for individual empowerment in order to gather resources that might promote general life satisfaction and social integration. Objectives: Schoolchildren assessment of oral health, BMI, eating habits, physical activity, sleep and health-related-quality-of-life. Materials and methods: This study was approved by the Ethics Committee of UFP. 214 children (6-16 years) from Vila Real district were observed. The following indexes were recorded: dmft, DMFT, DAI, Dean index, OHI-S and dental trauma. A semi-quantitative questionnaire related to oral health, eating Keywords: community dentistry, caries, nutrition, fluorosis, oro-facial trauma, oral health-related quality of life

Introduction: Weakened coronal structures can compromise tooth resistance to fracture, by occlusal loads, and may require reinforcement with restorative cusp coverage (CC). Objectives: To conduct a descriptive review of CC clinical options and to identify dental structural conditions that may guide the requirement of CC intervention for structure functional reinforcement. Methods: A search in Pubmed was carried with the keywords: Resin-based composite, Composite, Ceramic, Tooth fracture, Cusp coverage, Bicuspid, Weakened teeth, Cavity preparation design. Thirty articles were identified. Methodology included review, clinical and in vitro studies, published between 2005 and 2015 years. Results: Seven publications were selected. The CC can be executed through direct (composites) and indirect (ceramic materials and/or composites) restorative techniques. Several clinical conditions guide to CCs, such endodontically treated teeth, and in this group, premolars teeth are more susceptible to fracture, by anatomic factors as shape and location; and still, variations in cavity dimensions and cavity preparation designs. However, some authors suggested that less aggressive preparations are adequate rather than extended preparations over the cusps to prevent fracture, when using adhesive indirect restorations with resin-based composites. Conclusions: Cavity preparation design influence cusp stiffness: more deep and wide cavity designs promote cusp deflection greater loads. The remaining coronal structure, occlusal loads and the selected materials/techniques are important factors in CC restorative decisions. Clinical implications: Cusp coverage is a safe option to functionally restore posterior teeth with weakened remaining coronal structure Keywords: resin-based composite, ceramic, tooth fracture, cusp coverage, bicuspid, weakened teeth, cavity preparation design

Case Report: Patient JPVV, male gender, 18 years old, ASA 1, appeared in Oral Surgery department of FMUC on 27/06/14, referring diffuse pain in the upper jaw. After clinical examination, patient revealed vestibular swelling in region 11 and 12. After sensitivity tests, 11 showed negative response, consistent with necrotic pulp and 12 expressed no change. Diagnostic tests (Orthopantomography, apical X-ray and Cone-Beam) revealed the presence of a radiolucent unilocular and homogeneous lesion with well defined radiopaque edges at the level of the apical region of teeth 11 and 12. Treatment plan was, endodontic treatment of 11 associated with decompression and subsequent cystic enucleation. The pathologic results of incisional biopsy were consistent with an odontogenic radicular cyst. Periodic evaluations were made. Drain was removed 195 days after new Cone-Beam analysis, in which the almost complete regression of the lesion was observed. Patient is under surveillance, advancing to the surgery only if there is any recurrence. Discussion: Cystic decompression is a minimally invasive option, which through a decompressor system (drain) decreases intra-cystic pressure, promoting osteogenesis. It is a time consuming technique that requires high patient compliance. Conclusion: Cystic decompression is assumed as an alternative or a complement to a resective surgical technique, especially in cases of large lesions where immediate excision involve large bone destruction with possible impairment of noble anatomical structures. Keywords: odontogenic cysts, jaw cysts, cyst's treatment, cyst's decompression, enucleation

Objectives: To evaluate the effect of disinfection and sterilization, in the dimension stability of Imprint 4 Penta Putty (3M ESPETM) and analysis of the respective casts. Materials and Methods: 90 silicon samples were prepared with a metal matrix, according to the standard ISO 4823:2000 for the elastomeric impression materials. The samples' viability was confirmed by the presence of 75micra line and 9 groups were formed. Groups 1, 2 and 3 correspond to the Control at different times (0h, 24h, 1week); groups 4, 5 and 6 were submitted to 10 minutes immersion in sodium hypochlorite at 5.25% and measured at different times (0h, Tm, 24h, 1week); and groups 7, 8 and 9 were submitted to autoclaving at 134 °C for 40 minutes and they were also measured at different times. After the last measurement, the samples were passed to plaster type IV and it was confirmed the reproducibility of the 75micra line and it was also measured the dimensional stability. The measurements were made with a Michelson interferometer. Results: Following the silicone samples' dimensional change analyses, it was found that there weren't statistically significant changes over time (p> 0.05) in the Control and Hypochlorite groups. In the Autoclaving groups, it was concluded that except for the values obtained in Tm and 24h, all other values presented significant changes (p 0.05). For the casts, none of the groups presented significant statistically changes over time (p> 0.05). Conclusion: Both for silicones as for casts, the biggest changes were presented in the Autoclaving groups. The silicone samples must be passed to plaster after 24h printing. The changes found in silicones were bigger than those found in the plaster, which shows the highest capacity of the latter to maintain the initial reference values of the matrix. Keywords: dimensional changes, PVS, disinfection, sterilization, Michelson interferometer

Resume Introduction and Objectives In the last decades, a congenital defect of the enamel's mineralization known as Molar Incisor Hypomineralisation has become a worldwide growing concern for health professionals.The aim of this paper lies on the investigation of the prevalence and possible etiology related to the appearance of Molar Incisor Hypomineralisation in children aged between 7 and 9 years old. These children are patients in clinic of the Oporto University's Faculty of Dental Medicine. Materials and Methods The sampling was constituted by 70 children born between 2004 and 2006 showing, at least, one partially erupted permanent molar, who were seen in a Pediatric dentistry appointment at the Clinic of the Oporto University's Faculty of Dental Medicine. Results The prevalence of Molar Incisor Hypomineralisation in children who participated in this study was 13% with a greater incidence on the female sex (67%) and in the jawbones (13%). The majority of diagnosed MIH damages were moderate (89%). Regarding the different episodes related to children aged up to 4 years old, bronchiolitis, urinary infection, pneumonia and the frequent use of antibiotics (amoxicilin) were the problems most associated with hypomineralisation diagnosis. Clinical Implications Epidemiological studies suggest that the prevalence of MIH is increasing. It is important that professionals are able to establish a difference between different enamel defects, clinical signs must be carefully evaluated for the treatment success. Conclusions More studies should be conducted with more representative sample to draw more conclusions. Keywords: Molar Incisor hipomeralization

Description of clinical cases: Two clinical cases will be presented. Female patient, 21 years old, unhappy with the presence of unaesthetic spots on teeth of the anterior-superior sector (1.3-2.3) associated with demineralization lesions after removing the orthodontic appliances. Resin infiltration technique was performed. Male patient, 36 years old, dissatisfied with the appearance of his maxillary central incisors. We started by evaluating the extent and depth of white spot lesions by transilumination with light curing. The physical and clinical history evaluation led to the diagnosis of hypomineralization on teeth 2.1 and 1.1. Microabrasion enamel technique followed by resin infiltration technique were performed. Discussion: This method uses a low viscosity and photopolymerizable resin that acts by capillarity. This technique is easy to apply and does not lead to post-operative sensitivity. However, clinical cases should be thoroughly evaluated to assess the need for prior microabrasion or macroabrasion, as well as the need to subsequently add a composite to obtain satisfactory aesthetic results. Conclusion: Based on the satisfactory results obtained in both cases, we conclude that the resin infiltration technique is very promising and could be considered as a minimal invasive procedure. However, long term follow-up evaluation must be carried out to affirm the efficacy and durability of this type of treatment. Keywords: resin infiltration, white spot, minimal intervention dentistry, non-cavitated lesions, remineralization, enamel

Introduction: Behaviour management is essential in pediatric dentistry, basing itself on a set of techniques to improve communication, reduce anxiety and eliminate unwanted behaviours. Establishing verbal/non-verbal communication forms the basis of the consultation and underpins basic behaviour management techniques, such as tell-show-do, voice control, positive reinforcement, distraction and desensitization, among others. Selecting the technique to use should reflect the individual child's profile and the type of treatment needed. Aim: Performing a critical literature review of the different non-pharmacological behaviour management approaches used in paediatric dentistry. Methods: A search was performed using PubMed/Medline with the keywords "behaviour", "child", "basic communication techniques" and "pediatric dentistry" covering the last 10 years of English language publications with an indexed abstract. Results: The criteria used returned a total of 119 articles, 20 of which were selected following a content analysis of the abstract. Most articles were narrative reviews and clinical studies. An additional 5 articles were added following a process of cross-referencing. Conclusions: Although non-pharmacological behaviour management has shown itself to be crucial to pediatric dentistry, further studies need to be developed with more evidence of the effectiveness of the techniques being recommended. Clinical implications: Mastering these techniques increases trust between the dentist, the child and the caregiver, reduces anxiety, allows provision of the necessary dental care and promotes a positive attitude towards oral healthcare. The majority of children can be treated with basic techniques, while advanced techniques should only be considered following a cost-benefit analysis. Keywords: Behavior, basic communication techniques, pediatric dentistry, child

Clinical case description: A 31 year old male patient, with no relevant medical history, was fowarded by a colleague showing in a panoramic radiography, a lesion in the second quadrante. The CT scan confirmed the existence of a cyst in the area, also affecting the teeth 21 and 22. After doing the endodontic treatment of 23 the patient was medicated with amoxicilin 875 mg + clavulanic acid 125 mg, aceclofenac 100 mg and chlorhexidine 0.2%, to perfom the surgery. Discussion: Periapical injuries are amongst the most common pathological lesions of the alveolar bone. They are most often found in the anterior maxillary portion. This is related with the presence of epitelial waste and the high incidence of trauma in anterior teeth. Its location and morfology results in a higher probability of pulp necrosis. The removal of these lesions, is a sensitive work because, if they reach a considerable size, it may affect the oro-nasal communication, existing reported cases of bone destruction of the nasal cavity. Conclusion: Periapical lesions should initialy be treated with a nonsurgical endodontic treatment. If this treatment dows not result in success, the next step would be a surgical approach. A correct planning of the surgery accompanied by appropiate imaging exams, incresse the predictability of the intervention, reducing the postoperative inconveniences and the probability injury relapse. Keywords: Jaw, apical lesions, surgery, apicectomy, endodontics, anterior

Clinical case description: 41 year old male patient with no relevant clinical history, arrrived to the office presenting an apparent skeletal class III. After the clinical exam with correct mandibule manipulation, the patient reached a class I edge-to-edge occlusion. The treatment was started by using na occlusal splint in centric, to do a neuromuscular deprogramming for 12 months. After that time, an articulator montage and cephalometric study was done. The patient was then informed the duration of the treatment. Initially he would only wear braces in the upper jaw and then in the lower jaw. He was equaly informed that, dispite this treatment, he could still need na ortognatic surgery. Discussion: The Class III malocclusion is characterized by an inadequate anteror and posterior dental relationship, which may or may not be accompanied by skeletal changes. In general, the facial aspect is very committed, especially when associated with disability in the middle third. The diagnosis and treatment plan in malocclusion Class III of Angle should be performed judiciously. The patient must always be informed of the duration of the treatment plan, and with still the possibility of needing orthognathic surgery after treatment, depending on the progression of the case. Conclusion: The resulting treatment was satisfactory, both functionally and aesthetically. The unwinding of crossbite was possible. The midline alignment with stable occlusion was possible and the patient features good symmetry and adequate exposure of the upper incisors. Keywords: Class III angle, malocclusion, teeth, crossbite, jaw, surgery

Implant single-unit restorations have highly predictable results in terms of osseointegration, but its aesthetic integration frequently constitutes a challenge. This pilot study aims to compare the aesthetic outcome of patients receiving one single-unit implant restoration in the aesthetic zone with zirconia and titanium abutments by means of three of the aesthetic indexes proposed in the literature (PES/WES, ICAI and CIS), in order to understand if there is a correlation between them, as well as which of the abutments has a better aesthetic outcome. The participants (n=16) were submitted to a control visit, in which photographs were taken, a radiograph was collected and information regarding clinical aspects was obtained. The photographs were analysed by 19 external observers and one of the investigators. The correlation between indexes was calculated by the use of the Cohen's k and the internal consistency of the indexes was analysed by the Cronbach's α. There is an accordance between the absolute scores of the indexes, but there is no correlation when the cut-points, that discriminate an aesthetic from an unaesthetic outcome, are employed [PES/WES vs. ICAI (k=0.13)]. Before the same case, the ICAI has a 2.25 (1.96-2.59, 95% CI) higher risk to assign an unaesthetic outcome than the PES/WES. The PES/WES index has the higher internal consistency value (Cronbach's α=0.85). The cases with zirconia abutments were assessed as being more aesthetic than the ones with titanium abutments (p0.05). In conclusion, the PES/WES index appears to be the most consistent, although it lacks aspects related to overall aesthetics, such as the evaluation of the lip line. Within the limitations of this study, the cases with zirconia abutments were considered to have a better aesthetic outcome when compared to those with titanium abutments. However, more studies are necessary. Keywords: aesthetics, implant single unit restoration, titanium abutments, zirconia abutments, Pink Esthetic Score (PES), White Esthetic Score (WES), Implant Crown Aesthetic Index (ICAI), Copenhagen Index Score (CIS), peri-implant soft tissue

Introduction and Objectives: Generalized joint hypermobility (GJH) has been considered a predisposing factor for the development of Temporomandibular Disorders (TMDs). The literature refer that GJH is more frequent in females and tend to decrease with age. This study aimed to assess the relationship between GJH and the presence of TMD signs/symptoms and also with TMDs. Materials and Methods: Descriptive, cross-sectional, observational study, in 1381 university students from Oporto District. The study protocol was first approved by the Ethics Committee of University Fernando Pessoa and then by all the Institutions that were also visited. Demographic and TMDs symptoms questionnaire and clinical examination using the Portuguese version of the Research Diagnostic Criteria for Temporormandibular Disorders (RDC/TMD) as diagnostic system for TMD. The GJH evaluation was performed using Beighton Index (BI≥4 indicates GJH). Multiple logistic regression to identify risk factors associated to TMDs (one TMD diagnosis or multiple TMD diagnoses; reference: TMD free) (p=0.05/ 0.10 for inclusion/ exclusion). Results: Univariately facial pain, difficulty of mouth opening, clicking, muscular and articular pain are associated with GJH (p0.05). Multivariately, GJH, female gender and age increment are significant risk factors for TMD multiple diagnoses (OR=1.53 (95%CI:1.12-2.08); OR=1.98 (95%CI:1.31-2.98); OR=1.06 (95%CI:1.02-1.10), respectively). Conclusions: GJH, female gender and age are risk factors independently associated to TMD multiple diagnoses. Clinical Implications: Individuals with TMD associated to GJH should be carefully evaluated and, in some cases, treated by a multidisciplinary team. Keywords: Temporomandibular Joint, General Joint Hypermobility, Temporomandibular Disorder

Although dental caries is the most prevalent chronic disease worldwide, it is also the most preventable. The priority prevention strategy is health education, and pregnancy, a teachable moment, is the ideal life stage to start it. Education and preventive dental care should start during pregnancy and continue throughout a child's life. Keywords: Caries, Early Childhood Caries, Prevention, Pregnancy, Perinatal Period, Health Education

It is estimated that about 1 and 5 million third molar extractions are performed each year in the UK and USA, respectively. Despite the existence of defined indications and contraindications for the extraction of these teeth, there is some controversia about the treatment when the third molar is asymptomatic, even in literature. To analyse the indications regarding the extraction of asymptomatic mandibular 3M in a group of experienced Portuguese and Spanish dentists we performed na epidemiological oservational cross-sectional study. We observed that 59.3% of the practicians choose not to proceed with the extraction when facing an asymptomatic 3M and in 93% of the cases, Spanish give the extractions a higher score in terms of difficulty. Degree of difficulty is lower among those with more clinical experience (p0.05; CI 95%). Portuguese dentists are those who tend to extract these teeth more often. We concluded that clinical decision when facing asymptomatic mandibular third molar is related to dentists academic education and surgical experience. Keywords: Asymptomatic third molar, Oral surgery

Case report: A 48-year-old male patient went to our clinic with the purpose of fixed implant rehabilitation of the upper jaw. The periodontal diagnosis indicated the presence of severe generalized chronic periodontitis, with great involvement of several teeth, including all upper. Radiographic evaluation showed reduced bone quantity, with great pneumatization of the maxillary sinuses. Because it was an extreme case in terms of available bone, we decided to place five implants, with the placement of one implant on the nasopalatine canal. The other implants were placed in the remaining maxillary bone. During osseointegration period, the patient used a removable prosthesis. After 3 months of osseointegration, second surgical stage was performed and a metal-acrylic hybrid fixed prosthesis was fabricated. Discussion: Although the implants were placed in a palatal position, the patient didn't demonstrate problems with speech. In this clinical case, the nasopalatine neurovascular bundle was removed and implant site preparation was then performed. However, the patient didn't refer any sensory loss. In the literature, there are described some cases where sensory loss was refered but was trasitional and minimal. Conclusions: According to some studies, the placement of implants in the nasopalatine canal can offer a viable treatment approach for the rehabilitation of the severily atrophic maxilla, with great satisfaction of patients. The described procedure was successful, returning the patient's confidence in his smile. Keywords: implants, nasopalatine canal, fixed rehabilitation

Introduction: Oral rehabilitation with dental implants in the anterior mandible is a valid therapeutic approach. The presence of foramina allows the existence of a rich vascular plexus which can provoke several surgical complications. Objectives: To assess the utility of CBCT for: a) aiding in the determination of exact mandible anatomy; b) prevention of vascular surgical complications Methods: Article search was performed using Medline (PubMed) regarding foramina/vascular canals of the anterior mandible and CBCT technology, published between 2009 and 2015. The following words were used in the search: "mandibular lingual foramina cone beam". The search was completed with the review of the cited references of the selected articles in order to generate studies not initially identified. Inclusion criteria in the study: 1) Articles published between 2009 and 2015. 2) Articles in English. 3) CBCTs obtained from live human subjects. 4) Studies that evaluate the number of foramina and vascular canals in the anterior mandible. Exclusion criteria: a) Literature reviews. b) Articles performed in pediatric patients. c) Data obtained from cadaveric studies. d) Studies that don't include the anterior region of the mandible. Results: 9 articles were selected. Conclusions: The presence of foramina in the anterior mandible is frequent. CBCT is useful in the diagnosis and surgical planning of the anterior mandible. The information on the regional presence of foramina is important to reduce the occurrence f vascular surgical complications in the anterior mandible. Clinical Implications: The use of CBCT technology can reduce morbidity and increase predictability. Keywords: Foramina, Cone Beam

Introduction: In aesthetic rehabilitations, we must take into account the primary and secondary optical properties. Objectives: To evaluate the emission intensity of fluorescence between resin cement and glass-ceramic. Materials and Methods: two self-adhesive resin cements were used, as well as glass ceramic discs and composite resin. The ceramic cylinders were cut with a thickness of 1 and 0.5 millimeters and were bonded to composite resin discs with 0.5mm and polymerized for 40 seconds, for a total of n = 100. Fluorescence spectrums were obtained in a spectrofluorometer at a wavelength of 380 nanometers. Statistical analysis was performed using Student's t-test and one-way ANOVA, for a significance of p 0.05. Results: The samples of the control group were the ones who exhibited lower fluorescence with values of 1.99E13 a.u. in a thickness of 0.5mm and 2.95E13 a.u. in a thickness of 1 mm. In the samples of 1mm, all groups have similar values of fluorescence emission. In samples with 0.5mm, there are significant differences between each group (p 0.001) , in which the SCT group has higher fluorescence emission (1.06E14 a.u.). Conclusions: The thickness of the ceramic influences the final emission intensity of fluorescence. The emission intensity of fluorescence of the resin cements influences the final fluorescence of the glass ceramic. Clinical Implications: This study reveals the importance of the choice of the cement and ceramic thickness in a full ceramic rehabilitation. Keywords: Aesthetic rehabilitation, glass ceramic, resin cement, composite resin, optical properties, fluorescence

Case description: Female patient, 39 years old, came to the dental clinic for evaluation and treatment options for improving her smile. The patient has old restorations on 1.1 and 2.1, 1.2 and 2.2 rotated and bad positioned, edge to edge bite, inter-incisor's diastemas, gummy smile and a high smile line. After evalutation of the case and discussion of rehabilition possibilities, full-coverage crowns with alumina copings were made on 1.2, 1.1, 2.1 and 2.2. Discussion: The aesthetics was the first success intention. Teeth preparation and the provisional full-coverage crowns maintenance, made possible to obtain the perfect papillary shape. Full-coverage crowns allowed the closure of inter-incisors diastema, the alignment and correct positioning of tooth and solving the edge to edge bite. Conclusion: Although in the literature full-coverage crowns are considered a very invasive procedure, with this case report was possible to correct bad occlusion with fixed prosthesis which is described on the literature as a treatment option. Keywords: full-coverage crowns, inter-incisor diastema, gummy smile, high smile line, bad occlusion, papillar shape

Odontomas are considered the most common odontogenic tumors. They are usually assymptomatic and detected during routine radiographic exams. They are usually detected before 20. As odontomas can affect the normal eruption of teeth its early diagnosis is extremely important. The preferred treatment for this type of lesions is surgical removal, is not expected recurrence. A 12 years old, female, presented to the dental clinic with a proclination of 21. The diagnosis showed the presence of a radiopaque image near the root of 21. The proposed treatment was surgical removal of the lesion. It was confirmed the diagnosis of compound odontoma. Tracking the case it's important to evaluate further need of orthodontic treatment. Keywords: pediatric dentistry, tooth eruption, compound odontoma, surgical excision

Introduction: The success of oral rehabilitation depends on the accuracy and reproducibility of the impressions. Objective: The purpose is to study the dimensional changes of a polyether and addition silicone subjected to disinfection and sterilization after a long storage period. Materials and Methods: 90 samples were obtained from polyether Impregum Penta (3M ESPETM) and 90 of the addition silicone Imprint Penta Putty (3M ESPETM) according to ISO 4823:2000 and stored in the IPQ (Portuguese Institute for Quality) for six months. The measurements were performed by laser interferometry, according to the Michelson technique. The dimensional stability was calculated according to the formula specified in ISO 4823:2000. Results: A statistical analysis via a t-distribution for paired samples with a confidence interval of 95% was performed. The statistically significant expansion of Impregum Penta (3M ESPETM) was 0,77±0,17% in the control group, 0,42±0,19% in the hypochlorite group and 0,52±0,28% in the autoclave group. In the Imprint 4 Penta Putty (3M ESPETM), the control group had an expansion of 0,42±0,12%, the hypochlorite group 0,36±0,09% and the autoclave group 0,59±0,13%. Conclusion: The tested impression materials exhibit dimensional changes when subjected to disinfection and sterilization. These are not clinically significant because they are within the maximum extent permitted by the ISO 4823:2000. Clinical implications: The dimensional stability of impression materials subjected to disinfection, sterilization and long storage periods are critical to the success of the final prosthetic restoration. Keywords: Polyether, addition silicone, disinfection, sterilization, laser interferometry, dimensional stability

Introduction: Oral rehabilitation with implants in conditions with poor bone availability limits the treatment prognosis. The platelet-rich plasma (PRP) is one of the available technical possibilities for bone and soft tissue regenerations. Objectives: This narrative review aim to describe the advantages and limitations of using PRP in bone and soft tissues regeneration, when applied in oral implantology field. Methods: Research conducted in PubMed/Science Direct of publications from 1992 to 2015 years with the keywords: "Platelet-rich plasma", "Bone regeneration", "Dental Implants", "Periodontal Regeneration", "Growth Factor", "Regenerative implantology". To 85 articles were applied the inclusion criteria: review, clinical cases, and human or animal clinical trials publications. Results: Forty-two publications were selected. Several studies indicate that the PRP combination with other particulate bone substitutes promote acceleration of bone regeneration, in quantity and density of the new-formed bone. The use of PRP is not restricted to osteoconduction and agglutination grafts, and also provides leverage for soft tissue healing phenomena. These factors can be obtained by simple outpatient technique. However, some literature references suggest that tissue regeneration is not significantly high as well as the high-cost of these regeneration factors. Conclusion: The PRP promotes a faster bone and gingival regeneration; it is an autogenous product, so it does not promotes transmission of diseases and it does not show an immunological reaction. Keywords: Platelet-rich plasma, Bone regeneration, Dental Implants, Periodontal Regeneration, Growth Factor, Regenerative Implantology

Introduction: Fluorescence is an important optical property in restoring aesthetic aspects, once it can change on behalf of different light sources effects. Objectives: This narrative review aim to define the fluorescence concept, describing fluorescence analyzes methods and compare dental fluorescence with resin based composite (RBC). Methods: Research conducted in PubMed/Science Direct of publications from 1996 to 2015 years with the keywords: "Resin-based Composites", "Multishaded Dental Composite", "aesthetic shade restoration", "Optical properties", "Tooth fluorescence", "Spectrophotometer". Seventy-two articles were identified. Methodology included review, clinical case and in vitro trials publications. Results: Thirty-eight publications were selected. The most common procedures to evaluate the RBC fluorescence are: a spectrophotometer that performs the evaluation of the emitted intensity of fluorescence in nanometers of the tooth and RBC to be used; another procedure is based on a visual method with the use of Wood's light. According to literature, this method is economically advantageous. Several authors registered differences in RBC fluorescence when compared to natural teeth. Conclusion: The use of fluorescence assessment methods such as spectrophotometry and Wood's light, are auxiliary means for RBC selection, to be used in order to optimize the aesthetic restorative results. Clinical implications: The selection of the restorative material should match the fluorescence characteristics of the tooth structure to restore, in order to obtain favorable aesthetic output. Keywords: Resin-based Composites, Multishaded Dental Composite, Aesthetic Shade Restoration, Optical Properties, Tooth Fluorescence, Spectrophotometer

Introduction: Cross-infection between clinical and laboratory environments can occur in the absence of adequate biosafety procedures when carrying out Custom-made Medical Devices (CmMD). Objectives: Descriptive review of CmMD definition and enumeration of the main infection prevention/control methods, between clinical/laboratory environments, that can be applied to devices used when performing a CmMD. Methods: Search in PubMed between the years 2000-2015, with the keywords "dental prostheses", "disinfection protocols", "cross infection", "Infection control prosthodontic", "dental office", "dental impression disinfection", "sterilization", "dental laboratory." Four hundred four articles were identified. Methodology included narrative/systematic reviews and observational surveys. Results: Twenty-six publications were selected. Infection prevention/control methods were identified for the main devices used in the several steps (impressions, records, casts) of CmMD execution (acrylic and metal structures). Literature registers various methods, such as physical (autoclaving, UV, microwave, plasma), chemicals (different ranges of antimicrobial spectrum Disinfectants, by Spray and Immersion) and mixed (ultrasound). Transportation between clinical/laboratory settings should be done in container, which prevents leakage. Literature controversy over the choices that may be used when preparing for transport MD potentially contaminated and, gaps on the potential effects that these methods can produce to the used devices. Studies are needed to analyze the potential effects induced by the procedures in various stages of execution a CmMD. Conclusions: Infection prevention/control measures when performing a CmMD minimize cross-contamination between clinical/laboratory environments. Clinical Implications: Effective communication and application of appropriate biosafety procedures can promote protection of patient, professional teams involved and environments. Keywords: dental prostheses, disinfection protocols, cross infection, Infection control prosthodontic, dental office, dental impression disinfection, sterilization, dental laboratory

Description of the case: Female, 18 yo, patient, non smoker and with no systemic pathologies, presented an apical lesion in tooth 21, previously subjected to non-surgical, and surgical, endodontic treatment retrograde obturation with MTA. Due to the persistence of the lesion with recurring fistulization, the extraction, followed by ridge preservation techniques (xenograft and collagen membrane) were performed, in order to rebuild the bone architecture. After a healing period of nine months, a Straumann Bone Level (4.1x12mm) implant was placed, in the ideal 3D position; second surgical phase took place after 2 months with ISQ values of 77-81. The provisional crown, was modified three times in order to model the emergence profile of the final crown (4 months). At two years, hard and soft tissue stability is observed. Discussion: Tooth extractions lead to horizontal and vertical bone changes that may restrict the placement of an implant in ideal 3D position, jeopardizing future aesthetics. Six months after a tooth extraction, bone volume decreases 29-63%, horizontally, and 11-22%, vertically [1]. In order to maintain or increase the profile of the existing crest, ridge preservation techniques were developed [2]. The emergence profile must be modeled using a temporary crown, proving the stability of the tissues prior to execution of the final crown [3]. Conclusion: The ridge preservation technique previous to the implant surgery allowed the placement on the ideal 3D position. After 2 years hard and soft tissue stability is observed hard and soft tissues. Bibliografia 1. Tan, W.L., et al., A systematic review of post-extractional alveolar hard and soft tissue dimensional changes in humans. Clin Oral Implants Res, 2012. 23 Suppl 5: p. 1-21. 2. Hammerle, C.H., et al., Evidence-based knowledge on the biology and treatment of extraction sockets. Clin Oral Implants Res, 2012. 23 Suppl 5: p. 80-2. 3. Shor, A., R. Schuler, and Y. Goto, Indirect implant-supported fixed provisional restoration in the esthetic zone: fabrication technique and treatment workflow. J Esthet Restor Dent, 2008. 20(2): p. 82-95; discussion 96-7. Keywords: single-tooth dental implant, dental implant, aesthetics; dental, bone regeneration, Dental Restoration; Temporary, case reports

INTRODUCTION: Recently appeared on the market simplified adhesive systems (AS) designated as Universal (UAS) or "Multi-Mode" adhesives. OBJECTIVE: Descriptive review of UAS regarding labelling (composition, solvent, acidity) advantages over Etch&Rinse (ER) and Self-Etch (SE) systems and performance evidences. METHODS: Literature search in MEDLINE/PubMed, Science Direct was conducted, between the years 2010-2015, with the keywords: "Dentin/Enamel bonding agents", "self-etch adhesives," "etch&rinse adhesives", "universal adhesives", "multimode adhesives", "simplified adhesives". Fifty articles were identified. Methodology included publications of meta-analysis, narrative/systematic review, in-vitro and clinical trials. RESULTS: Seventeen publications were selected: one meta-analyse, one systematic review, 13 in vitro and two clinical trials. UAS labelling/pH/solvent were registered: Scotchbond Universal (3M/ESPE); Futurabond U (Voco); Clearfil Universal Bond (Kuraray); XenoSelect (Dentsply); All-Bond Universal (Bisco); G-Bond Plus (GC); Adhese Universal (Ivoclar Vivadent); Peak Universal Bond (Ultradent). In most, the solvent is ethanol with or without water; classified as mild (pH≈2) ultra mild (pH> 2.5) in acidity. Main advantage associated with versatility of instructions for use (ER and/or SE). UAS effectiveness appears to depend on the chemical composition; more research is needed to determine their clinical performance. CONCLUSIONS: UAS do not greatly differ from traditional ER/SE systems; Chemical interaction is a crucial characteristic of UAS to enhance durability of dentin-resin interfaces. Similar performance to some SE, but less than some ER adhesives especially in enamel. CLINICAL IMPLICATIONS: UAS although versatile in application do not match technological innovation when compared to traditional ER and SE. AS innovation requires bio-protective and bio-promoter effects in the enamel and dentin. Keywords: Dentin/Enamel bonding agents, self etch adhesives, etch & rinse adhesives, multimode adhesives, universal adhesives, simplified adhesives

Introduction: Variations in tooth architecture parameters can influence patients and dentistry professionals (D) concerning smile aesthetic perceptions. Objectives: Qualitative evaluation/comparison of patients and Dentistry students' perceptions regarding tooth architecture parameters and smile aesthetic appearance. Material and Methods: An observational, cross-sectional study, approved by UFP-Ethics Committee. Two photographs (intraoral: maximum occlusion; extra-oral: smile) were taken to 35 patients (74.3% women) of CPMD-UFP. Patients completed the survey (Personalized Aesthetic Evaluation), self-assessment, after watching their own photographs. Thirty-eight FHS-UFP Dentistry students registered tooth micro/macro-aesthetic parameters (Aesthetic Checklist; Fradeani, 2004) after observing the photographs. Descriptive statistical analysis/comparison with chi-square test (α = 0.05). Results: Patients: satisfaction with tooth shade (60%), with smile (80%), beautiful smile (83%); Interest in changing smile aesthetics (42.9%). Students: square/ovoid (40.8%) tooth shape, normal tooth shade (53%), average tooth length (61.7%), higher CI dominance (66.2%), tooth midline without deviation (55%), normal tooth axes (52.2%), tooth proportionality (51%), tooth asymmetry (54%); 36.4% of smiles considered aesthetic. Patients versus student's compliance ratio (p0.001) in all evaluated criteria, except regarding the tooth midline parameter. More studies should be applied to different populations and rehabilitation fields. Conclusions: Most patients showed satisfaction with their tooth architecture/smile aesthetics; patients' perceptions versus students were in agreement on almost all tooth macro/micro-aesthetic parameters evaluated. Clinical Implications: Tooth architecture/Smile aspect analysis is a communication tool for professional/scientific criteria and patient expectations in planning cosmetic/aesthetic changes. Keywords: Tooth architecture, aesthetic smile, tooth shade, shape, texture and position

Introduction: In addition to being a method of communication between the intervenients of an oral rehabilitation, the diagnostic wax-up (DW) is a helper when it proves necessary to change the vertical dimension of occlusion (VDO). Objective/Methods: This clinical review intends to evaluate the parameters achieved by the execution of a DW in aesthetic rehabilitations in the anterior teeth with DVO increase. Bibliographic research was performed on PubMed/Medline with the key-words: "wax-up AND DVO", "diagnostic wax-up" and "anterior dental aesthetics". Systematic reviews, narrative reviews and clinical cases, published in the last 10 years, were included. Results: 14 publications meet the inclusion criteria. There are several DW techniques, including the progressive one. In the presence of large dental destruction with DVO increased, DW restores the worn portion of teeth, looking to determine the correct occlusion plane, balanced simultaneous posterior contacts and the anterior guide. From the DW is possible to acquire mock-ups, temporary or permanent restorations, as well as guides that present themselves as auxiliaries in rehabilitation. Conclusions: Planning through study casts articulated in centric relation with DW execution makes it possible to determine details that aid rehabilitations that need DVO increase. Clinical implications: In rehabilitations that include accentuated aesthetic and functional changes, among them the DVO increase, DW is a process that ensures a better predictability of results. Keywords: wax-up and VDO, diagnostic wax-up and anterior dental aesthetics, predictability and wax-up, tooth wear and wax-up, diagnosis, planning

Introduction: The reprocessing of reusable medical devices (MD) is a key-element in clinical settings infection control, being reported in several medicine fields. Objective: To perform a descriptive review of clinical dental instruments definition as MDs and to describe concepts of MD reprocessing and traceability processes in dentistry. Methods: Research was performed in PubMed between the years 2000-2015, with the keywords: "cross-contamination", "disinfection", "sterilization", "reusable instruments", "reprocessing", "traceability" and "dental medical devices". Five hundred and sixty three papers were identified. Research methodology included narrative/systematic reviews, and observational studies of reprocessing/traceability processes; publications regarding the effects in MD resistance, efficacy of methods and equipment processing were excluded. Results: Sixteen papers were selected. Dental instruments are included in the MD category and regulated by law. Depending on the nature and complexity of the MD, several methods can be applied, recognizing their characteristics and limitations. MD reprocessing/traceability involve several stages and may include: disassembly, cleaning, disinfection, inspection, testing for functionality, packaging, sterilization and storage, requiring detailed records, logistical capacity and appropriate training. The instructions of MD manufacturers fall short of the necessary regulatory requirements, with information gaps that may limit those processes. Literature description is scarce, being necessary further studies applied to particularities of the dentistry clinical environment. Conclusions: The reprocessing/traceability processes depend on the MD type, instructions issued by MD manufacturers, professional training and require documented and validated records, there being no standard protocol. Clinical implications: The possibility of reprocessing/tracing reusable MD assures resources optimization and promotes patients and dentistry team safety. Keywords: Cross-contamination, Disinfection, Sterilization, Reprocessing, Traceability, Medical Devices

Immediate Dentures (ID) are medical custom-made devices that can be perform before or during a rehabilitation planning and, is therefore made with limited protocol criteria when compared to a restorative prosthesis. The aim of this work was to describe and ilustrate the criteria regarding the clinical aspects where removable acrilic partial dentures are indicated. Keywords: immediate removable prosthesis, immediate denture, immediate complete denture, immediate parcial denture, provisional dental prosthesis, acrilyc denture

DESCRIPTION OF THE CLINICAL CASE Female patient, aged 22, showed up for an appointment of occlusion at SAMS - Centro Clínico de Lisboa refering muscle pain and fatigue after arousal, level 70 using the visual analogique scale (VAS) when performing palpation of both Masseteres muscles. She mentioned that she had been using a oral appliance for over 3 years and has an acentuated dental wearing with dentin exposure. The final diagnostic of the Temporomadibular Disorder with muscular origin was estabilishied through the axis I of Diagnostic Criteria for Temporomandibular Disorders (DC//TMD). In this precise case the ETPS therapy was selected with one session per week, on a total of 3, each one during 10 minutes and with a 150 Hz frequency in the Masseteres. At the begining and ending of each session a review of pain performing palpation of the Masseter and Temporal muscles was made, using VAS. DISCUSSION The results are consistent with the published literature.The high, levels of pain during palpation in both masseteres gradually decreased in every session, specialy in the trigger points. CONCLUSIONS ETPS is an effective method of pain control for TMD with muscle disorder, even when the oral appliance didn't show effective. Keywords: TMD, ETPS, Pain, Muscular

The osteogenic distraction should be considered as a treatment option for mandibular retrognathism. Case report: Female patient, 21 years old, Class II, hyperdivergent, with mandibular retrognathia requiring combined orthodontic-orthognathic surgery treatment. A custom-manufactured dental-anchored distractor was placed. Surgically, an incision was performed bilaterally on the mucosa with subperiosteal detachment, revealing the alveolar and basal bone and the outer face of the body of the mandible. Then the corticotomy of the external and internal cortical plates was performed using a Lindemann drill, between the lower premolars, with slight deviation in order to preserve the continuity of the inferior alveolar neurovascular bundle, osteotomy being carried out with an osteotome. After checking bone mobility, the distractor was tested and a plane suture was performed. After 7 days of latency, the process of increasing the mandibular length was initiated, with a distraction rate of 1 mm/day for 10 days. After the distraction period, the device was locked, followed by a period of consolidation. To control the osteogenesis process, panoramic radiographs were performed. The osteogenic distraction is an alternative to mandibular bilateral sagittal split osteotomy, with the advantage of not requiring intermaxillary fixation, the recovery room period is minimal, there is less pain and less paresthesia, making it a non-disabling procedure. Additionally, the use of a dental-anchored distractor allows its placement and removal without demanding surgery. The osteogenic distraction using a dental-anchored distractor was efficient in the sagittal lengthening of the jaw. Keywords: mandibular, osteogenic distraction, distractor

Introduction: The harmonious combination of color, texture, shape and gingival architecture is of utmost importance in the aesthetic perception of smile. Objectives: Qualitative evaluation/comparison of patients and Dentistry students' perceptions regarding the gingival architecture and aesthetic appearance of the smile. Materials and Methods: An observational, cross-sectional study approved by Ethics Committee of UFP. Two photographs were taken (intra/extra-oral) to 35 patients (74.3%-women) of Pedagogical Dentistry Clinic-UFP, which subsequently completed a survey (Personalized Esthetic Evaluation) on their gingival/smile appearance. Thirty-eight students of FCS-UFP registered gingival criteria (Esthetic Checklist; Fradeani, 2004) after observing those photographs. Descriptive statistical analysis/comparison with chi-square test (α=0.05). Results: Patient' self-assessment: 94.3% likes their gingival color, 74.3% regular gingival margins, 77.1% has no gingival exposition, healthy gums 74.3%, 88.6% satisfied with gingival appearance, but 48.6% would improve their gums. Checklist of gingival parameters by Students: symmetric margin (60.3%), regular zenith (53.5%), papillae present (80%), alterations (gingival inflammation/recession) (61.9%), ordinary normal tonality (48.6%) and gingival aesthetic line (51.4%). Agreement relationship between patients and students perceptions, in all evaluated criteria (p0.05). More studies should be conducted to compare qualitative/quantitative aspects of the gingival architecture. Conclusions: The comparison of patients and students' perceptions proved to be compliant in all assessed parameters of gingival/smile aspects, occurring variation on the degree of agreement (low to high) in some parameters. Clinical Implications: The analysis of the patient/professional perceptions, on gingival architecture/smile aspects, enables communication synergism on esthetic/cosmetic rehabilitators' decisions. Keywords: Gingival aesthetic, gingival contour, gingival architecture, smile aesthetic, macro-aesthetic, micro-aesthetic

Objective: The aim of this observational and analytical case-control study was to verify the association between inflammatory bowel disease and periodontal disease. Methods: The sample was selected among the patients from the General Gastroenterology and Inflammatory Disease Clinic of the Hospital Garcia de Orta, Almada, Portugal, with a diagnosis of Crohn's disease or ulcerative colitis who have agreed to participate in this study. For each patient we determined the values of the Community Periodontal Index and the Simplified Oral Hygiene Index. We also obtained data regarding oral hygiene habits, smoking habits, drug therapy, duration and activity of inflammatory bowel disease. The control group consisted of healthy individuals accompanying the study group patients to their appointments. Results: The Community Periodontal Index (0-5) showed values of 2.0±1.07 for the control group and 2.8±0.98 for the study group. This difference was statistically significant (p0.0001), showing a higher severity of periodontal disease in these patients. The periodontal status deteriorated in the course of the disease, but not in a statistically significant way. Conclusions: There was a positive association between periodontal disease and inflammatory bowel disease, since the patients suffering from this disease showed more severe periodontal affections when compared with the controls. Keywords: Inflammatory Bowel Disease, Crohn's Disease, Ulcerative Colitis, Periodontal Disease

Case clínic presentation: Male, 64 years old, non-smoker, retired (concierge), send trough PIPCO (Oral Cancer Early Detection [Portuguese] Project) Through the clinic examination is detected a oval lesion, sessil, elevated, limits clearly defined, approximated width 1,5x1cm, hard touch, non-bleeding, yellow-redish, with 3 months of evolution without any trigger. The lesion was documented also in photograph and it was submitted to an excisional biopsy for histologic exam with a squamous cell oral carcinoma as a first impression diagnosis. The dental practitioner are the most privileged physician able to observe the oral cavity in a dental routine appointment, so they are in the front line do detect this kind of lesion in the earliest stage as possible. At the moment, this case is one of the 14 national cases detected among 2500 clinical evaluations, and 320 biopsies, which by itself uphold this kind of project.The oral cancer is rising so prevention is the most important measure that National Public Health can implement toward the better life expectation of the Portuguese population as seen in others medical areas. Keywords: Oral Squamous Cell Carcinoma, Prevention, PIPCO

Introduction: Individuals with abusive alcohol behaviours are a risk group for dental erosion due to chronic and cumulative exposure to extrinsic and intrinsic factors. Objective: To quantify dental erosion prevalence and severity in alcoholic detoxification patients and to determine associated risk factors. Material and methods: Analytical cross-sectional study conducted to measure dental erosion in 300 institutionalized patients for alcohol detoxification in Withdrawal Units -"IDT Norte". A self-report questionnaire was registered, regarding socio-demographic characteristics, pathologies, alcohol/drugs consumption behaviours and oral hygiene measures. Clinical examination was performed with BEWE approach to quantify erosion. A logistic regression model was applied to identify variables/factors significantly associated to dental erosion risk (p = 0.05/0.10 inclusion/exclusion). Results: In 169 patients with quantified erosion, using BEWE, dental erosion prevalence was 100%; 62.1% categorized as having medium/high risk of dental erosion. Average cumulative BEWE score was 10.1±3.56. 83.3% men, overall mean age 42.2±8.6 years. Multivariate analyses showed that female gender (OR=23.0 (95%CI:2.5-212)) and, not using mouthwashes (OR=5.6(95%CI:1.7-20)) are significantly associated with medium/high risk of tooth erosion (p0.05). Time with gastro-oesophageal disease lasting more than 1 year is non-significantly associated with dental erosion risk (p=0.057, OR=3.2 (95%CI:0.96-10.7)). Conclusions: This population showed a high prevalence and medium/high risk for dental erosion and, female gender and not using mouthwashes are significantly associated with risk for dental erosion. Clinical Relevance: In dental erosion epidemiological analysis, BEWE approach makes possible to quantify and categorize the individual risk for dental hard tissues loss. Keywords: Erosion, alcoholism, BEWE, erosive wear, prevalence, erosive risk